title: The feasibility of meta-cognitive strategy training in acute inpatient stroke rehabilitation: case report.
abstract: Meta-cognitive strategy training may be used to augment inpatient rehabilitation to promote active engagement and subsequent benefit for individuals with cognitive impairments after stroke. We examined the feasibility of administering a form of meta-cognitive strategy training, Cognitive Orientation to daily Occupational Performance (CO-OP), during inpatient rehabilitation. We trained an individual with cognitive impairments after right hemisphere stroke to identify performance problems, set self-selected goals, develop plans to address goals, and evaluate performance improvements. To assess feasibility, we examined the number of meta-cognitive training sessions attended, the number of self-selected goals, and changes in goal-related performance. We also examined changes in rehabilitation engagement and disability. The participant used the meta-cognitive strategy to set eight goals addressing physically oriented, instrumental, and work-related activities. Mean improvement in Canadian Occupational Performance Measure Performance Scale scores was 6.1. Pittsburgh Rehabilitation Participation Scale scores (measuring rehabilitation engagement) improved from 3.2 at admission to 4.9 at discharge. Functional Independence Measure scores (measuring disability) improved from 68 at admission, to 97 at discharge. Performance Assessment of Self-Care Skills scores improved from 1.1 at admission to 2.9 at discharge. The results indicate that meta-cognitive strategy training was feasible during inpatient rehabilitation and warrants further evaluation to determine its effectiveness.
authors.affiliation: Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA 15260, USA. skidmore@pitt.edu
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Skidmore
authors.forename: Margo B
authors.initials: MB
authors.lastname: Holm
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Whyte
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Deirdre
authors.initials: D
authors.lastname: Dawson
authors.forename: James T
authors.initials: JT
authors.lastname: Becker
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000150:complications / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004185:Disability Evaluation; D005240:Feasibility Studies; D006040:Goals; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D009483:Neuropsychological Tests; D010349:Patient Compliance / Q000706:statistics & numerical data; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D013663:Teaching / Q000379:methods*